Human joints, in particular the knee, hip and spine, are susceptible to degeneration from disease, trauma, and long-term repetitive use that eventually lead to pain. Knee pain, for example, is the impetus for a wide majority of medical treatments and associated medical costs. The most popular theory arising from the medical community is that knee pain results from bone-on-bone contact or inadequate cartilage cushioning. These conditions are believed to frequently result from the progression of osteoarthritis, which is measured in terms of narrowing of the joint space. Therefore, the severity of osteoarthritis is believed to be an indicator or precursor to joint pain. Most surgeons and medical practitioners thus base their treatments for pain relief on this theory. For example, the typical treatment is to administer pain medication, or more drastically, to perform some type of joint resurfacing or joint replacement surgery.
However, the severity of osteoarthritis, especially in joints such as the knee and ankle, has been found to correlate poorly with the incidence and magnitude of knee pain. Because of this, surgeons and medical practitioners have struggled to deliver consistent, reliable pain relief to patients especially if preservation of the joint is desired.
Whether by external physical force, disease, or the natural aging process, structural damage to bone can cause injury, trauma, degeneration or erosion of otherwise healthy tissue. The resultant damage can be characterized as a bone defect that can take the form of a fissure, fracture, microfracture, lesion, edema, tumor, or sclerotic hardening, for example. Particularly in joints, the damage may not be limited to a bone defect, and may also include cartilage loss (especially articular cartilage), tendon damage, and inflammation in the surrounding area.
Patients most often seek treatment because of pain and deterioration of quality of life attributed to the osteoarthritis. The goal of surgical and non-surgical treatments for osteoarthritis is to reduce or eliminate pain and restore joint function. Both non-surgical and surgical treatments are currently available for joint repair.
The technique of subchondrally treating joints affected by osteoarthritis (OA) to relieve the associated pain, as well as treat the underlying disease, has been previously described by applicant. This subchondral treatment involves the stabilization and/or stimulation of the subchondral space at the area of the joint damaged by osteoarthritis, while also preserving as much as possible the articular surface of the joint. This subchondral treatment may be applied to all joints of the human body such as the knee, hip, shoulder, and spine and includes smaller joints such as ankle, elbow, and wrist joints.
In some cases, the ease with which the subchondral treatment developed by applicants is administered depends in large part on the instrumentation that is available to effect the treatment. In the case of subchondral defects that reside near the peripheral articular surface of a joint, precise, controlled and repeatable targeting of the subchondral region of the bone may be particularly challenging due to the inherent natural topography (i.e., curvature) of the bone and the limited area with which to perform the treatment method. Accordingly, it is desirable to provide instruments that can better facilitate treatment in this region of the joint, as well as associated methods.